University of Virginia Library

1. STANDING.

We shall find this apparently uncomfortable position assumed even at the present day, and in our own country: Thus, Dr. H. F. Campbell, of Georgia, writes me that he has delivered a patient standing, clinging to the bed-post, who would rather dispense with his services than assume any other position. Among our Indians it is rarely observed, although I have been informed by a correspondent that the Sioux women are delivered standing erect; I think

that we shall find a partially erect, partially standing, position more frequent among them. The natives of the Antilles, if we may accept so venerable an authority as Fray Juan de Torquemada, are confined standing, but also at times assume the kneeling or recumbent postures. In France it seems to have been quite a common position in some of the interior departments, as Godefroy[7] warns his colleagues never to permit the women to be confined in a standing posture, as hemorrhage, prolapse of the uterus, and rupture of the perineum are more apt to ensue than in any other. During the past century it seems to have been the most common position among the Sclavonians in the mountainous regions of upper Silesia, where, in 1747, a physician, in his book on midwifery, even advises such patients as do not wish to be confined in bed to assume this position, with some strong person supporting them from behind and holding their arms, whilst others hold the separated legs, and the midwife sits comfortably in front.[8]

The Hindoos, especially upon the eastern coast of India and in the vicinity of Madras, are delivered in an erect, standing posture, supported by an assistant under each shoulder—the midwife attending to her duties, being seated in front of the patient,[9] and whether rare or not at the present day the position is certainly traditionary, as bas-reliefs still exist upon the ancient Indian monuments which represent the act of delivery in this very same way.

In Central Africa, and near the Cape, among the Boers, the standing posture is not uncommon. Among the Negritos, upon the Philippine Islands, the parturient woman assumes the standing position, but apparently bent forward a little, as she supports the abdomen against a bamboo cane planted in the ground, thus apparently exercising some pressure upon the uterus.[10] Among the Wakambas, in Africa,

the patient assumes the standing posture assisted by two friends, but bends over backwards, and a third is seated in front to receive the child.[11]

A similar position is shown in an old painting in the Academy of Medicine in New York. (See Fig. 5.) The

history of this picture, which represents some mythical or mythological scene, I cannot trace, but the artist has certainly depicted the custom of his period in the position assumed by the parturient. For this reason it has appeared to me of sufficient interest to place it side by side with the labor scene among the less fanciful Wakambas.

The Loangos, in Equatorial Africa, are delivered standing, leaning against the wall of the hut, or kneeling, the head resting upon the arms. The reason assigned for this procedure is that they expect to obtain the desired head presentation by assuming these positions. In difficult labor

the patient is placed upon her face and chest, and finally upon her back, and choked and kneaded until an expulsion in some direction is accomplished.[12]